The DSM-5 and International Psychology
For the past six weeks, I have been taking a class called “Abnormal Psychology” at the Global Online Academy. The class explores different mental disorders and questions how our society defines “normal” in the psychology realm, particularly what stigmas and stereotypes play into how we perceive “abnormal.” I chose to take this class because the Global Online Academy is an international academy, so I have classmates from across the world. Having classmates that live in various countries across the world like China, India, the United Kingdom, and many more, creates a unique classroom dynamic that features perspectives from people of different locations and does not have a United States-centered curriculum. Because of the diversity in our class, we have recently been discussing the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition(DSM-5) and how it shapes Psychology on an international level.
First, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or the DSM-5 is essentially a book used for diagnosing mental disorders. Writted and published by the American Psychiatric Association, the DSM-5 contains descriptions of the criteria and symptoms associated with different mental disorders. Most often, psychologists reference the DSM-5 when working with patients to help determine their specific psychological diagnosis. The DSM-5 is an extremely important part of psychology, defining and shaping what society considers psychologically “abnormal” and “normal”. In fact, the DSM-5 is so foundational to psychology that a common nickname for the book is the “Bible of psychology,” especially since it is used around the world. However, the DSM-5 has recently received heavy criticism for defining mental disorders through a western-centered lens, while being used on patients internationally.
In my abnormal psychology class, we read the book Crazy Like Us: The Globalization of the American Psyche by journalist Ethan Watters that contemplates the accuracy of the DSM-5 in an international context. In the book, Watters argues that Americans present their version of mental illnesses such as anxiety, depression, and anorexia as the global version of that mental illness. In other words, Watters is saying that different countries or even just different areas have different cultures that shape the mental illnesses present in that area. Watters believes that different environments create different kinds of mental illnesses and therefore those mental illnesses have different solutions or treatments based on their cultural environments. So, when the United States tries to force its environment-specific definitions of mental illness and treatments or solutions to mental illness, they are ignoring the cultural boundaries that define mental illnesses differently in different areas.
And upon further research, I have concluded that Watters is right: the same psychological disorder in different locations can be drastically different. An example of a local culture altering the presentation of a mental disorder is schizophrenia in Zanzibar. In comparison with Americans, people in Zanzibar who have schizophrenia are not nearly as isolated from the rest of society due to stigmas surrounding schizophrenia. In America, it is surely “abnormal” to exhibit the symptoms of schizophrenia, but the same is not true in Zanzibar. Particularly, in Zanzibar it is more socially acceptable to hear voices or see spirits due to the religious culture. 99% of Zanzibar’s population is Muslim, a religion where there are angels, demons, and the jinn, which are both good and bad. Unlike in the Christian religion, these spirits were not immediately cast out when they “possessed” a person. Put simply, hearing voices or experiencing visual halluciantions is more normalized in Zanzibar, whereas it is stigmatized in America. Thus, schizophrenic people in America are stigmatized and socially isolated in comparison to schizophrenic people in Zanzibar.
This othering of people with different psychological experiences ultimately leads to the schizophrenic experience in western countries to be more negative. In an experiment featuring people from the United States and Zanzibar, researchers found that the social contexts of schizophrenia has actually changed how the mental disorder presents itself in each location. Because of the negative social perception of schizophrenia in the United States, patients reported hearing voices that threated violence or exhibited insidious intentions, while patients in Zanzibar reported hearing voices that were harmless and more friendly. In the case of schizophrenia, the DSM-5 could not be used to accurately diagnose a patient.
Additionally, Watters believes that money plays a major role in the international distribution of the nation-specific DSM-5. Watters notes that major pharmaceutical companies benefit from America’s “one size fits all” attitude toward mental health because if the world believes there is one, best solution to a particular problem(and that solution is a drug!) then the pharmaceutical company can take advantage of the public perception of their product as the only solution to their mental illness.
Personally, I agree with Watters’s argument about the DSM-5, but the debate is still on going. Either way, I think it is productive to rethink how we define “normal” and “abnormal” in psychology. For more information, here is an NPR article about Watters and his book Crazy Like Us: The Globalization of the American Psyche: